• Rashid Alobaidi, Catherine Morgan, Stuart L Goldstein, and Sean M Bagshaw.
• Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
• Pediatr Crit Care Me. 2020 Jan 1; 21 (1): 82-91.

ObjectivesWe describe the epidemiology, characteristics, risk factors, and incremental risks associated with acute kidney injury in critically ill children at a population-level.DesignPopulation-based retrospective cohort study.SettingPICUs in Alberta, Canada.PatientsAll children admitted to PICUs in Alberta, Canada between January 1, 2015, and December 31, 2015.InterventionsNone.Measurements And Main ResultsA total of 1,017 patients were included. Acute kidney injury developed in 308 patients (30.3%; 95% CI, 28.1-33.8%) and severe acute kidney injury (Kidney Disease: Improving Global Outcomes stage 2 and 3) developed in 124 patients (12.2%; 95% CI, 10.3-14.4%). Incidence rates for critical illness-associated acute kidney injury and severe acute kidney injury were 34 (95% CI, 30.3-38.0) and 14 (95% CI, 11.38-16.38) per 100,000 children-year, respectively. Severe acute kidney injury incidence rates were greater in males (incidence rate ratio, 1.55; 95% CI, 1.08-2.33) and infants younger than 1 year old (incidence rate ratio, 14.77; 95% CI, 10.36-21.07). Thirty-two patients (3.1%) did not survive to PICU discharge. The acute kidney injury-associated PICU mortality rate was 2.3 (95% CI, 1.4-3.5) per 100,000 children-year. In multivariate analysis, severe acute kidney injury was associated with greater PICU mortality (odds ratio, 11.93; 95% CI, 4.68-30.42) and 1-year mortality (odds ratio, 5.50; 95% CI, 2.76-10.96). Severe acute kidney injury was further associated with greater duration of mechanical ventilation, duration of vasoactive support, and lengths of PICU and hospital stay.ConclusionsThe population-level burden of acute kidney injury and its attributable risks are considerable among critically ill children. These findings emphasize the need for enhanced surveillance for acute kidney injury, identification of modifiable risks, and evaluation of interventional strategies.

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